STATE OF FLORIDA L AGENCY FOR HEALTH CARE ADMINISTRATION 4p OBES , PROVIDENCE PROPERTY AND CASUALTY INSURANCE COMPANY; DALLAS FIRE INSURANCE COMPANY and AMS STAFF LEASING, INC., Petitioners, and MEDNET CONNECT, INC., Intervenor, Vv. STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. / iisins ig, Ou Vigey Vig DOAH CASE NO. 05-0801 AHCA NO. 2004008713 BMHC CASE ID 20040809.048 FINAL ORDER THIS CAUSE concerns a Second Amended Petition for Formal Administrative Hearing (“Petition”) that the Agency for Health Care Administration (“Agency”) received pertaining to agency action of August 27, 2004. On March 8, 2005, the Agency referred the Petition to Division of Administrative Hearings (“DOAH”) where they were assigned to an Administrative Law Judge (“ALJ) for further proceedings and later consolidated into one matter. On January 26, 2006, the ALJ entered an Order Granting Motion to Withdraw as Counsel for Petitioners/Intervenor, allowing the Petitioners and Intervenor’s attomey to withdraw and stating that if-a notice of appearance was not filed by the Petitioners and Intervenor by February 6, 2006, the file would be closed at DOAH. On February 3, 2006, the Intervenor filed a Notice of Withdrawal of Intervention and Voluntary Dismissal as to Fairpay, stating that it no longer had an interest in this matter. On February 7, 2006, the ALJ entered an Order Closing File based on the fact that no . notice of appearance had been filed by the Petitioners. The Petitioners have not made any attempts to continue prosecuting this matter since February 7, 2006. Based upon the foregoing, IT IS THEREFORE ORDERED AND ADJUDGED THAT: The Petition is dismissed with Prejudice and the Agency’s August 27, 2004 Determination is hereby upheld. Unless they have already done so, Petitioners shali submit the correct reimbursement amounts to HCA Healthcare Company within 30 days of the date that this final order is rendered, and shall submit proof of reimbursement to: Donna Reynolds, R.N., Agency for Health Care Administration, Workers’ Compensation Medical Services Unit, 200 East Gaines Street, Tallahassee, Florida 32399-4232. Petitioner shall govern itself accordingly. DONE and ORDERED this di day of Copaeet , 2008, in Tallahassee, Florida. HEALTH CARE ADMINISTRA’ fl ON HOLLY BENSON, Secretary NOTICE OF RIGHT TO JUDICIAL REVIEW A PARTY WHO IS ADVERSELY AFFECTED BY THIS FINAL ORDER IS ENTITLED TO JUDICIAL REVIEW, WHICH SHALL BE INSTITUTED BY FILING THE ORIGINAL NOTICE OF APPEAL WITH THE AGENCY CLERK OF AHCA, AND A COPY ALONG WITH THE FILING FEE PRESCRIBED BY LAW WITH THE DISTRICT COURT OF APPEAL IN THE APPELLATE DISTRICT WHERE THE AGENCY MAINTAINS ITS HEADQUARTERS OR WHERE A PARTY RESIDES. REVIEW PROCEEDINGS SHALL BE CONDUCTED IN ACCORDANCE WITH THE FLORIDA APPELLATE RULES. THE NOTICE OF APPEAL MUST BE FILED WITHIN 30 DAYS OF THE RENDITION OF THE ORDER TO BE REVIEWED. CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing Final Order has been furnished by U.S. or interoffice mail to the persons named below on this AS day of RICHARD J. SHOOP, Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, MS #3 Tallahassee, Florida 32308 (850) 922-5873 COPIES FURNISHED TO: Honorable Harry L. Hooper Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 Gail A. Lane, Esquire AMS Staff Leasing, Inc. 14160 Dallas Parkway, Suite 500 Dallas, Texas 75254 Mari H. McCully, Esquire Department of Financial Services Division of Workers’ Compensation 200 East Gaines Street Tallahassee, Florida 32399-4229 Steven Polino, Esquire Fairpay Solutions, Inc. 14295 Midway Road, Suite 300 Addison, Texas 75001 HCA Healthcare Company Patient Account Services — Tampa Bay 31975 U.S. Highway 19 North Palm Harbor, Florida 34684 Jan Mills Facilities Intake Unit Elizabeth Dudek Health Quality Assurance

Docket for Case No: 05-000801